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Hager A, Guo Y, Wang Y, Mazurak V, Gilmour SM, Mager DR. Exercise rehabilitation to treat sarcopenia in pediatric transplant populations. Pediatr Transplant 2023; 27:e14602. [PMID: 37746869 DOI: 10.1111/petr.14602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND In adult transplant (Tx) populations, exercise rehabilitation strategies may improve sarcopenia components (muscle mass [MM], strength [MS], and physical performance [PP]). Limited data are available regarding exercise rehabilitation therapy in pediatric Tx populations. METHODS The purpose of this review is to critically evaluate the feasibility and impact of exercise programs (EP) that include resistance exercise (RE) on markers of sarcopenia in pediatric Tx populations. Literature searches in SCOPUS and WEB OF SCIENCE were conducted to identify studies applying EP with a RE component in pediatric populations in the Tx setting. RESULTS Twelve articles (2008-2022) met inclusion criteria. The exercise interventions varied in length (3 weeks-12 months), intensity (low to moderate), time pre/post Tx (0 days-5 years post Tx), age of participants (3-18 years), adherence (63%-94%), and methodologies to measure components of sarcopenia. No studies measured all three components of sarcopenia concurrently. Approximately, 60% of studies found positive effects on MS and PP. Only one pediatric study measured body composition, therefore, the effect of exercise programs with RE components on MM is unknown. CONCLUSIONS Exercise programs may be a beneficial treatment for sarcopenia in Tx populations, particularly in components of MS and PP. Studies measuring all three aspects of sarcopenia together in response to RE training in pediatrics remains an important gap. Studies that include body composition measurements in response to exercise are needed. Special considerations for the development of RE programs in pediatrics Tx populations are safety, supervision, engagement through family/peer involvement and incorporation of game/play-based elements.
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Affiliation(s)
- Amber Hager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yuxin Guo
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yiqi Wang
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Vera Mazurak
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Susan M Gilmour
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Diana R Mager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Burghall A, Ruhl M, Rosaasen N, Groot B, Flood K, Davis K, Minakakis N, Wichart J, Mansell H. A scoping review of pediatric transplant education. Pediatr Transplant 2023; 27:e14578. [PMID: 37528694 DOI: 10.1111/petr.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Education is crucial for pediatric patients and caregivers throughout the transplant continuum, yet data are lacking around which interventions are effective and in what circumstances. METHODS We undertook a scoping review with the objectives of (a) describing the types, effects, and outcomes of patient-focused educational interventions before and after pediatric transplant and (b) understanding the educational experiences of patients and caregivers. Five scientific databases were explored for relevant literature using the JBI methodology. Educational interventions published in English, targeting pediatric solid organ transplant patients (0-25 years) and their caregivers were included. Relevant data from eligible articles (n = 27) were extracted and summarized. RESULTS Eighteen articles describing 17 educational interventions were identified for objective A, and nine articles qualitatively assessing patient or parental learning needs were identified for objective B. Most interventions were directed toward teenage patients and their caregivers post kidney transplant, primarily focusing on medication self-management and adherence, or providing general information on transplant using multicomponent delivery formats. Most interventions achieved statistically significant improvements in knowledge (n = 8/9) and patients or caregivers expressed satisfaction with the intervention (n = 7/7) but health-related outcomes such as medication adherence (n = 2/6) or behavior change (n = 1/3) rarely achieved statistically significant results. In objective B, patients and caregivers described the transplant process as overwhelming, but indicated that social supports and education helped them cope. Participants consistently wanted more information than they received. CONCLUSION Caregivers and pediatric patients value transplant education, but high-quality studies are limited. Since education is a fundamental part of the transplant process, future research in this area should be prioritized.
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Affiliation(s)
- Ashley Burghall
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michelle Ruhl
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
| | - Brianna Groot
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kayla Flood
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Keefe Davis
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jenny Wichart
- Canadian Donation and Transplantation Research Program, Canada
- Department of Pharmacy, Alberta Health Services, Edmonton, Alberta, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
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Singer P. Post-transplant education for kidney recipients and their caregivers. Pediatr Nephrol 2022:10.1007/s00467-022-05744-6. [PMID: 36227432 DOI: 10.1007/s00467-022-05744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
Successful outcomes in pediatric kidney transplantation require the involvement of the transplant team as well as recipients and their caregivers. Enhancing patient and family understanding of the disease and of post-transplant care can result in improved adherence and outcomes. Educational strategies should aim to be broad, understandable, innovative, and inclusive while maintaining a tailored approach to individualized care. Teaching should not be viewed as a one-time event but rather as an ongoing conversation throughout the duration of care, emphasizing different aspects throughout the patient's various developmental stages. The following review article discusses the content and methods of post-transplant education.
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Affiliation(s)
- Pamela Singer
- Department of Pediatrics, Cohen Children's Medical Center-Long Island Jewish Medical Center, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
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4
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Düken ME, Zengin M, Yayan EH. The effect of perceived social support on the psychosocial status of parents whose child had liver transplantation. J Pediatr Nurs 2022; 66:e130-e136. [PMID: 35527086 DOI: 10.1016/j.pedn.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to describe parental psychosocial outcomes following paediatric liver transplantation and the relationship between parental psychosocial outcomes and social support. METHOD This is a correlational, descriptive study conducted between April 2021 and October 2021 in the paediatric hepatology polyclinics of the liver transplantation institute of a university hospital. The SPSS 25 and AMOS 23 package programmes were used to perform data analyses. RESULTS Data analysis revealed that the parents' social support level was low (44.6 ± 14.8), while their levels of trait anxiety (51.5 ± 4.8) and loneliness (48.5 ± 5.4) were high, and their depression level was moderate (26.4 ± 5.8). Established structural equation modelling demonstrated that the social support parents received had a significant effect on their levels of loneliness (β = -0.88; p < 0.001), trait anxiety (β = -0.37; p < 0.001), and depression (β = -0.44; p < 0.001). CONCLUSION The authors conclude that in parents of children who have had a liver transplant, increased levels of perceived social support result in decreased levels of anxiety, loneliness, and depression. PRACTICE IMPLICATIONS The authors recommend that healthcare professionals can contribute to reducing the anxiety, loneliness and depression in parents of paediatric liver transplant recipients by strengthening their social support systems.
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Affiliation(s)
- Mehmet Emin Düken
- Department of Child Health and Diseases Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Mürşide Zengin
- Department of Child Health and Diseases Nursing, Faculty of Health Sciences, Adıyaman University, Adıyaman, Turkey.
| | - Emriye Hilal Yayan
- Department of Child Health and Diseases Nursing, Faculty of Nursing, İnönü University, Malatya, Turkey
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Chen CB, Chugh S, Fujiki M, Radhakrishnan K. Overview of Physical, Neurocognitive, and Psychosocial Outcomes in Pediatric Intestinal Failure and Transplantation. Curr Gastroenterol Rep 2022; 24:145-155. [PMID: 36040624 DOI: 10.1007/s11894-022-00848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Intestinal failure and transplantation may significantly impact physical, neurocognitive, and psychosocial development in pediatric patients. Currently, there is a paucity of literature on the effects of intestinal failure and transplantation on these aspects of development. This article will review the current literature and discuss the short and long-term impacts as well as interventions to improve clinical outcomes in children with intestinal failure or those undergoing transplantation. RECENT FINDINGS Psychological disorders, neurodevelopmental delay, and social maladaptation are frequently encountered in this patient population. While the main focus is often on medical management, equal emphasis should be placed on other aspects of development such as increasing social support and improving school performance. The transition to adulthood also presents many obstacles for patients and healthcare providers should anticipate challenges such as childbirth, employment, and raising a family. The pre-operative, perioperative, and post-operative periods all represent opportunities for medical intervention. Frequent monitoring of physical, psychosocial, and neurocognitive status helps to improve clinical outcomes and long-term quality of life. Future research should emphasize continued development of multidisciplinary programs and specialized services to help address the physical and psychosocial needs of children with intestinal failure as well as transplant recipients.
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Affiliation(s)
- Charles B Chen
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St, 65201, Columbia, MO, USA.
| | - Shreeya Chugh
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St, 65201, Columbia, MO, USA
| | - Masato Fujiki
- Center for Gut Rehabilitation and Transplantation, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, 44195, Cleveland, OH, USA
| | - Kadakkal Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Ave, 44195, Cleveland, OH, USA
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6
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Mäenpää H, Tainio J, Jalanko H, Arokoski J, Jahnukainen T. Physical performance after pediatric solid organ transplantation. Pediatr Transplant 2022; 26:e14163. [PMID: 34661328 DOI: 10.1111/petr.14163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Low physical activity is a well-recognized problem in pediatric solid organ transplant recipients; however, little is known about the differences between transplant groups. Physical performance testing was performed in a cohort of pediatric kidney, liver, and heart transplant recipients. METHODS Fifty-one patients (54.9% boys), including 17 liver, 20 kidney, 2 combined liver-kidney, and 12 heart transplant recipients, were tested at the median age of 11.5 (7.5-14.9) years. The results were compared with a control group, which consisted of 425 healthy schoolchildren. The physical performance test included six different tests of endurance, strength, flexibility, and speed. RESULTS The transplant recipients performed worse on most tests when compared with the control subjects (leg-lift test 42.0 vs. 44.9 repetitions, p = .002; repeated squatting 21.6 vs. 23.9 repetitions, p < .001; sit-up test 9 vs. 17 vs. 9 repetitions, p < .001, back extension 20 vs. 35 repetitions, p < .001; and shuttle run test 26.5 vs. 23.7 seconds, p < .001). None of the test results differed statistically significantly between the transplant groups. CONCLUSION The physical performance of pediatric solid organ transplant recipients is lower than that of their healthy peers but do not differ between different transplant groups. More systematic rehabilitation programs and follow-up are needed.
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Affiliation(s)
- Heidi Mäenpää
- Department of Rehabilitation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juuso Tainio
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Jalanko
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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McLoughlin A, Wilson C, Swords L. Parents' Experiences of Their Child's Solid-Organ Transplant: A Meta-Ethnography of Qualitative Studies. J Pediatr Psychol 2021; 47:279-291. [PMID: 34664643 DOI: 10.1093/jpepsy/jsab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this paper was to conduct a systematic review and meta-ethnography of qualitative studies examining the experiences of parents adjusting to life after the solid organ transplant (SOT) of their child. METHODS A systematic review of the literature was conducted to identify qualitative studies that examined this topic. The search retrieved 4,964 studies to review against inclusion criteria. A total of 21 studies were included in the meta-ethnography. A reciprocal translation was conducted to compare themes identified in each study. A line of argument synthesis was then conducted in order to integrate the similarities and differences between all of the studies into a new interpretative context. RESULTS The synthesis identified four themes: (a) adjusting to life after transplant, (b) factors that facilitate adjustment, (c) factors that disrupt adjustment, and (d) changes caused by transplant. As a result of the synthesis, a new interpretation of parents' experiences of adjusting to life after the SOT of their child was constructed. A summary figure is presented. CONCLUSION This review found that while parents may struggle to adapt to life post-transplant and the demands of caring for their child, the experience can also result in the development of new skills, a new appreciation for life, and viewing the self in a more positive manner. A better understanding of parental experiences will promote the development of more effective interventions for the adjustment of parents and families to post-transplant life.
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8
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Forner-Puntonet M, Castell-Panisello E, Quintero J, Ariceta G, Gran F, Iglesias-Serrano I, Gisbert-Gustemps L, Daigre C, Ibañez-Jimenez P, Delgado M, Español-Martín G, Parramon G, Pont T, Ramos-Quiroga JA. Impact of COVID-19 on Families of Pediatric Solid Organ Transplant Recipients. J Pediatr Psychol 2021; 46:927-938. [PMID: 34313783 PMCID: PMC8344614 DOI: 10.1093/jpepsy/jsab058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic and lockdown measures have had a clear psychological impact on families, and specifically those with children with chronic illnesses have reported greater overloads and exhaustion. The objective of this study was to evaluate the exposure, impact and experience of the pandemic on families of pediatric solid organ transplant (SOT) recipients compared to families of healthy children and adolescents. METHODS We recruited 96 families, 48 with a pediatric SOT recipient and 48 healthy controls, matched by child age and gender. A primary caregiver from each family responded to an online sociodemographic questionnaire and the COVID-19 Exposure and Family Impact Survey (CEFIS), which explores the exposure, impact and experience of the pandemic and lockdown on families. RESULTS Exposure to the pandemic was greater in families of healthy children and adolescents. The impact was mostly negative in both groups: caregivers reported increased anxiety (76%) and mood disturbances (71.9%) and hindered quality of sleep (64.6%) and health habits (58.3%). On the positive side, family relationships improved. Qualitatively, the SOT group positively perceived isolation and established hygienic measures as protective and destigmatizing, although they reported fear of virus transmission to their child. CONCLUSIONS The psychological impact of the pandemic has been similar in both groups, although families of transplant recipients have protected themselves more, probably because they are used to prevention measures and they see contagion as a graver risk. Additionally, SOT recipients' families presented some idiosyncratic elements, especially a decrease in their perception of stigma associated with the medical condition.
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Affiliation(s)
- Mireia Forner-Puntonet
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
| | | | - Jesús Quintero
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - Gema Ariceta
- Pediatric Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona
| | - Ferran Gran
- Pediatric Cardiology Department, Hospital Universitari Vall d’Hebron
| | | | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Pol Ibañez-Jimenez
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
| | | | - Gemma Español-Martín
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Gemma Parramon
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
| | - Teresa Pont
- Department of Donor and Transplant Coordination, Hospital Universitari Vall d'Hebron
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
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9
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Hind T, Lui S, Moon E, Broad K, Lang S, Schreiber RA, Armstrong K, Blydt-Hansen TD. Post-traumatic stress as a determinant of quality of life in pediatric solid-organ transplant recipients. Pediatr Transplant 2021; 25:e14005. [PMID: 33769652 DOI: 10.1111/petr.14005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 01/15/2023]
Abstract
Living with end-stage organ failure is associated with an accumulation of traumatic medical events, and despite recovery after solid-organ transplantation (SOT), many children continue to exhibit lower quality of life (QOL). Few studies have examined the relationship between post-traumatic stress disorder (PTSD) and QOL among pediatric SOT recipients. We conducted a retrospective, cross-sectional review of 61 pediatric SOT recipients (12 heart, 30 kidney, and 19 liver) to evaluate the association of PTSD with self-reported QOL. PTSD was measured by the Child Trauma Screening Questionnaire (CTSQ), and QOL was measured using the PedsQL and PedsQL Transplant Module (PedsQL-TM) surveys. Demographics, baseline, and contemporaneous factors were tested for independent association. SOT recipients were 15.2 (12.1-17.6) years old at survey completion. Median CTSQ score was 2 (1-3), highest in kidney recipients, and 13% were identified as high risk for PTSD. Median PedsQL score was 83 (70-91) and significantly associated with the CTSQ score (r = -.68, p < .001). Median PedsQL Transplant Module score was 89 (83-95) and similarly associated with the CTSQ score (r = -.64, p < .001). Age at time of surveys and presence of any disability were also independently associated with PedsQL and PedsQL-TM, respectively. When adjusted for Emotional Functioning, CTSQ remained associated with PedsQL subscores (r = -.65, p < .001). Trauma symptoms are a major modifiable risk factor for lower self-perceived QOL and represent a potentially important target for post-transplant rehabilitation. Additional research is needed to understand the root contributors to PTSD and potential treatments in this population.
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Affiliation(s)
- Tatsuma Hind
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Lui
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Moon
- Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Katherine Broad
- Social Work, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Samantha Lang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard A Schreiber
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada
| | - Kathryn Armstrong
- Department of Pediatrics, Division of Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
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10
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Bobrowski AE. School and sports participation post-transplant. Pediatr Transplant 2021; 25:e13791. [PMID: 33202076 DOI: 10.1111/petr.13791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/07/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Pediatric recipients of life-saving organ transplants are living longer, with improved graft and overall survivals. After successful transplant, children are encouraged to return to "normal life," with school attendance and participation in age-appropriate physical activities. This transition may cause stress to the recipients, parents, teachers, and other participating caregivers and staff. Planning for school reentry and assuring education for and open lines of communication with the school staff can help alleviate some of this discomfort and ease the process for the patient and the family. Cardiovascular disease has emerged as the leading cause of death in survivors of pediatric transplantation and is contributed to by modifiable risk factors such as obesity, hypertension, and the MS. Physical activity is a proven tool in decreasing surrogate markers of this risk. Sports participation is an important way to promote an enjoyment of physical activity that can ideally persist into adulthood, but conflicting advice and opinions exist regarding type and participation in physical activity. Moreover, specific recommendations are likely not applicable to all recipients, as certain degrees of rehabilitation may be needed depending on degree and length of illness. In general, a program of rehabilitation and increased physical activity has been shown to be safe and effective for most pediatric transplant recipients. Focusing on optimizing the "normal" childhood activities of going to school and participating in sports can improve the physical, social, cognitive, and mental health outcomes of this population after transplant and should be prioritized.
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Affiliation(s)
- Amy E Bobrowski
- Division of Pediatric Kidney Diseases, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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11
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Albert J, Hanisch B, Sgambat K. Approaches to safe living and diet after solid organ transplantation. Pediatr Transplant 2021; 25:e13783. [PMID: 32721079 DOI: 10.1111/petr.13783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 12/24/2022]
Abstract
SOT recipients are at high risk for developing severe infectious complications following discharge from the hospital. Comprehensive anticipatory guidance surrounding everyday lifestyle choices can potentially prevent exposure to infectious agents from the environment. This paper reviews the risks that pediatric and adolescent SOT recipients encounter through exposures such as household contacts, outdoor activities, travel, animal exposures, and dietary choices. Although strong evidence is lacking, this paper makes recommendations aimed at minimizing the risk of infectious complications and hospitalization in pediatric SOT recipients.
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Affiliation(s)
- Jonathan Albert
- Pediatric Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA
| | - Benjamin Hanisch
- Pediatric Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA
| | - Kristen Sgambat
- Pediatric Nephrology, Children's National Hospital, Washington, District of Columbia, USA
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12
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Garcia Guerra G, Bond GY, Joffe AR, Dinu IA, Hajihosseini M, Al-Aklabi M, Robertson CMT, Urschel S. Health-related quality of life after pediatric heart transplantation in early childhood. Pediatr Transplant 2020; 24:e13822. [PMID: 32871049 DOI: 10.1111/petr.13822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited information about HRQL after pediatric heart transplantation at a young age. METHODS Prospective follow-up study of children who received a heart transplant at age ≤4 years. HRQL was assessed using the PedsQLTM 4.0 at age 4.5 years. This cohort was compared with healthy children, children with CHD, and with chronic conditions. Peri-operative factors associated with HRQL were also explored. RESULTS Of 66 eligible patients, 15 (23%) died prior to the HRQL assessment and 2 (3%) were lost to follow-up, leaving 49 patients. Indication for transplantation was CHD in 27 (55%) and CMP in 22 (45%). Median age (IQR) at transplant was 9 (5-31) months. HRQL was significantly lower in transplanted children compared to population norms (65.3 vs 87.3, P < .0001), children with chronic conditions (65.3 vs 76.1, P = .001), and children with CHD (65.3 vs 81.1, P < .0001). Transplanted children with CHD had lower HRQL than those with a prior diagnosis of CMP (59.5 vs 72.5, P-value = .020). Higher creatinine pretransplant and higher lactate post-operatively were associated with lower HRQL. CONCLUSION Children after heart transplant had significantly lower HRQL, as reported by their parents, than the normative population, children with chronic conditions, and children with CHD.
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Affiliation(s)
- Gonzalo Garcia Guerra
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen Y Bond
- Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ari R Joffe
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Irina A Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | | | - Charlene M T Robertson
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Comparison of Quality of Life and Caregiving Burden of 2- to 4-Year-Old Children Post Liver Transplant and Their Parents. Gastroenterol Nurs 2020; 43:310-316. [PMID: 32740021 DOI: 10.1097/sga.0000000000000448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A literature search determined there are no studies on children between 2 and 4 years of age who have had a liver transplant and their parents. For this reason, this study aimed to compare the quality of life of children between 2 and 4 years of age who have had a liver transplant, and the caregiving burden of their parents. The study was carried out as a descriptive cross-sectional study on 47 children who visited Inonu University Liver Transplant Institute outpatient clinic between March 2017 and March 2018. This study found that 59.6% of the children with transplants were male and 38.3% had their organ donated by their mother. There was a positive relationship between the quality of life of the parents and the quality of life and subdimensions of the children. There was a negative relationship between parental quality of life and care burden. This study found that the quality of life of children with liver transplants and their parents was low and, as the quality of life of children was impaired, the caregiving burden of parents increased. Healthcare professionals' awareness of the effect of caregivers' care load on quality of life after liver transplantation can positively affect the healing process.
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Cavalli C, Tarzia V, Marini M, Gregori D, Casella S, Bottio T, Toscano G, Fraiese AP, Gambino A, Volpe B, Gerosa G. A comparison of quality of life and psychological distress in heart transplantation patients at adult and pediatric ages. Clin Transplant 2020; 33:e13335. [PMID: 29935045 DOI: 10.1111/ctr.13335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the current study was to evaluate and compare the quality of life (QOL) and psychological status of adult patients who underwent heart transplant (HTx) at pediatric or adult ages. METHODS The population consisted of two groups: patients who received HTx after 18 years old and pediatrics who received HTx between the age of 1 and 18 years. At the time of the study, all patients were over 18 years old. QOL data were collected from patients using 36-item Short-Form Health Survey (SF-36) and psychological distress by the Symptom checklist 90-revised questionnaire (SCL-90-R). RESULTS A total of 232 HTx patients were evaluated; 217 were transplanted at an adult age and 15 at a pediatric one. QOL improved significantly in pediatrics patients in the general health perceptions subscale and physical pain subscale than adult patients. The Global Index of the psychological distress did not differ in the two groups, but the pediatric patients registered statistically significant higher scores on the interpersonal sensitivity symptom subscale (adult group 36 ± 0.42 vs pediatric group 81 ± 0.79), the hostility subscale (adult group m 39 ± 0.44 vs pediatric group 73 ± 0.76) and the paranoid ideation subscale (adult group 46 ± 0.46 vs pediatric group 96 ± 1.02). CONCLUSION The pediatric heart recipients showed better quality of life, but they show marked sensitivity, hostility and paranoid ideation which increases the risk of mental distress and therefore their adherence to medical treatment.
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Affiliation(s)
- Chiara Cavalli
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Dario Gregori
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Tomaso Bottio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Toscano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Angela Pompea Fraiese
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio Gambino
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Brosbe MS, Wright LK, Cantor R, Dreyer WJ, Kirmani S, Knight M, Nakano SJ, Kindel SJ, Ryan TD, Kirklin JK, Deshpande SR. Educational and learning morbidity in pediatric heart transplant recipients: A pediatric heart transplant society study. Pediatr Transplant 2020; 24:e13711. [PMID: 32320118 DOI: 10.1111/petr.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 11/29/2022]
Abstract
Educational development is an important component of quality of life for children with heart transplant. Aims include determining prevalence of and risk factors for modified education placement in a large representative sample of pediatric heart transplant recipients. Participants included 1495 patients (age 6-18 years) from the PHTS database. Data on education placement and clinical predictors were collected at listing and at 1 and 3 years post-transplant. At listing, 88% of patients were in typical education placement, while 12% were in modified education. Males (P = .02), those with CHD (P < .0001), those with non-private insurance (P < .0001), and those with longer hospital stay (P = .001) were more likely to be in a modified education placement at time of listing. Age, race, listing status, mechanical support, and waitlist time were not significantly associated with placement. The prevalence of typical education placement was similar (87% at 1-year and 86% at 3-year) post-transplant. Predictors of modified education placement at 3-year follow-up included placement at listing (OR = 12.9 [95% CI 7.6-21.9], P < .0001), non-private insurance (OR = 2.0 [95% CI 1.3-3.2], P = .001), CHD (OR = 1.8 [95% CI 1.1-2.7, P = .01), history of post-transplant infection (OR = 1.9 [95% CI 1.2-2.9, P = .007), and number of post-transplant infections (OR = 1.3 [95% CI 1.1-1.5, P = .002). Among pediatric heart transplant recipients, males, those with non-private insurance, those with CHD, and those who experience post-transplant infections are at greatest risk for modified academic placement, which persists for several years post-transplant and deserves targeted intervention.
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Affiliation(s)
| | | | - Ryan Cantor
- University of Alabama at Birmingham, Birmingham, Alabama
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Lerret SM, Johnson NL, Haglund KA. Parents' perspectives on caring for children after solid organ transplant. J SPEC PEDIATR NURS 2017; 22. [PMID: 28371009 DOI: 10.1111/jspn.12178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/27/2017] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore parents' experiences of the transition from hospital to home and complex chronic illness management following their children's solid organ transplant (SOT). DESIGN AND METHODS Qualitative component of a larger mixed methods longitudinal study. Parents of SOT recipients were interviewed three times following hospital discharge from five major pediatric transplant hospitals in the United States. RESULTS Analysis of parent interviews (N = 48) resulted in three themes that characterized the phases of transition to home and complex chronic illness care. Three themes, corresponding to the three time periods of data collection, included "getting back to normal" at 3 weeks, "becoming routine" at 3 months, and "facing a future" at 6 months. Challenges families experienced over the course of their transition are also described. PRACTICE IMPLICATIONS The transition from hospital to home and complex chronic condition care is challenging and changes over time. Nurses are called upon to prepare parents to become knowledgeable and confident to care for the child after hospital discharge. Nurses can best support families in transition after SOT by anticipating and understanding their dynamic challenging complex care needs.
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Affiliation(s)
- Stacee M Lerret
- Department of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Norah L Johnson
- College of Nursing, Marquette University, Milwaukee, WI, USA
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Ethical Considerations in the Psychosocial Evaluation of Pediatric Organ Transplant Candidates, Recipients and Their Families. ETHICAL ISSUES IN PEDIATRIC ORGAN TRANSPLANTATION 2016. [DOI: 10.1007/978-3-319-29185-7_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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